Pediatric Education and Research

Background: Growing pains being episodic benign pains are often over diagnosed and under evaluated. Case Characteristics: A 4-year-old girl presented with complaints of frequent intermittent knee joint pain especially nocturnally. Serum profile studies were within normal limits. Ultrasound of both knee and hip joint was normal. MRI of right knee showed patellar osteitis with retropatellar serositis. Outcome: A short course of oral steroids resulted in symptomatic relief within 3 days where a treatment for 4 months with NSAIDs could not provide major relief.

Keywords: Growing pains; Retropatellar serositis; Kohler’s disease; Naish and Apley diagnostic criteria.

Myocardial ischemia and myocardial infarction is rare in children, with Kawasaki disease in children and substance abuse in adolescents, being the main cause. We present a case of a 12-year child suffering from Dengue, with bicuspid aortic valve, complicated by aortic valve insufficiency, who presented with chest pain and ECG changes of myocarditis and acute coronary syndrome; a rare occurrence. He was referred to us with complains of fever, cough, black colored stool, burning abdominal pain, and vomiting after 4 days of hospitalization at a district hospital as dengue illness. On day 9 of illness, he developed large hematemesis, with severe precordial chest pain, and was diagnosed initially as a case of acute myocardial ischemia due to myocarditis following dengue fever. ECG showed ST depression and troponin-I was markedly raised. Oxygen, ventilator, inotropes, streptokinase in divided doses (after bleeding had stopped), and steroids, zinc and vitamins C, E were administered. ECG changes reversed in a few hours and q waves started to appear. Later, 2D ECHO showed bicuspid aortic valve with aortic valve insufficiency. Myocardial enzymes, troponin-I and ECG returned to normal after 14 days. He was discharged on cardio supportive medications and advised valve replacement. Bicuspid aortic valve may remain undiagnosed till adolescence and can present rarely as acute myocardial ischemia following Dengue that was treated with streptokinase.

Keywords: Bicuspid aortic valve; Adolescent; Electrocardiogram; Acute myocardial infarction; Streptokinase; Dengue.

Background: Scrub typhus is known to cause meningitis in children. Literature on neuroimaging findings in scrub typhus is very scarce. Case characteristics: A case of acute meningoencephalitis with raised intracranial tension demonstrated basal meningeal enhancement and ventricular prominence on CECT brain. In view of clinical nonresponsive and CECT findings, antitubercular therapy was started. Subsequently rickettsial serology came out to be positive for Orientia tsutsugamushi; good response was observed to doxycycline. Outcome: Dramatic clinical response to doxycycline was observed favoring a diagnosis of scrub typhus meningitis.

Keywords: Scrub typhus; Tuberculous meningitis; Basal meningeal enhancement.

Introduction: Thalassemia is genetic blood disorders inherited from a person’s parents that can result in the abnormal formation of hemoglobin. In beta thalassemia major ineffective erythropoiesis, frequent blood transfusions lead to iron overload. Excessive iron can cause irreversible organ damage. Iron overload can be measured by serum ferritin levels. Aims and objectives: To study iron toxicity due to blood transfusion in patients of thalassemia major. To study the correlation between iron toxicity and serum ferritin levels. Correlation between iron toxicity and number of blood transfusions. To study growth parameters in thalassemia penitents pertaining to iron toxicity. Methods: Fifty cases of thalassemia major were enrolled. Detailed history and clinical examination was done and blood samples collected to test for serum ferritin levels. Ferritin levels were performed by using indirect enzyme-linked immunosorbent assay (ELISA) kit along with normal and abnormal controls. Data were analyzed to determine the association between variables. Results: Majority of the patients were in ≤5 years of age (40%) followed by 6–10 years (32%). Sixty-four percent subjects were male and 36% were female. At baseline majority of the children (44%) were having serum ferritin level between 1000 and 2500 ng/ml followed by 2501 and 4000 ng/ml (32%) and 4001 and above (14%). At the last follow-up serum ferritin level was observed to be increased with majority having serum ferritin level between 1000–4000 ng/ml (68%). At the last follow-up it was observed that the total dose of iron chelator was increased as compared to baseline and was statistically significant. Conclusion: Thus we conclude that majority of the children suffering from thalassemia major were having iron toxicity due to blood transfusion at the baseline and at the last follow-up also. Increasing age and number of transfusions were significantly associated with serum ferritin levels statistically. Positive correlation between Sr. Ferritin level and chelation was observed at the baseline and at the time of last follow-up also.

Keywords: Thalassemia; Enzyme-linked immunosorbent assay (ELISA); Serum; Hemoglobin.

Objectives: Present study was performed with an objective to compare complication rates & average duration of stay between, peripherally located catheter tip, non–centrally (intermediate) located catheter tip and centrally located catheter tip of percutaneously inserted central catheter (PICCs) in neonates. Material and methods: Present retrospective cohort study was performed at level III neonatal care in neonates who underwent PICCs placement through saphenous vein. We analyzed the data of the neonates from our NICU from March 2009 to September 2009 who underwent PICCs placement. Patients demographics, catheter duration and catheter complications were analyzed retrospectively. Catheter tip location was determined by X-ray. Difference in the complication rates, premature removal rates and average duration of stay in peripheral, non-central (intermediate) and central groups were analyzed. Results: Data of total 49 neonates was analyzed. Of the 49 PICCs, in 16 (32.6%) catheter tip was in peripheral location, in 23 (46.9%) catheter tip was in non-central (intermediate) location and in 10 (20.4%) catheter tip was central location. The peripheral group had complication rate of 81.2% (13/16), while the intermediate group had complication rate of 26% (6/23), and central group had no complications. Average duration of stay of catheter in peripheral group was 7.1 days, intermediate group was 10.7 days, and central group was 28.3 days. Conclusion: Placement of the tip of the PICCs beyond the sapheno femoral junction even though not central is acceptable in standard care of newborn.

Keywords: Percutaneously inserted central catheter (PICCs); Neonatal.

Introduction: Worldwide, the incidence of congenital anomalies is estimated at 3–7%, but actual numbers vary widely between countries. There is a paucity of Indian literature on birth defects. Aims and objectives: (1) To Study the Proportion of birth defects in live births in a tertiary care teaching hospital in rural central India. (2) To followup these birth defects for a period of 2 months and to study the outcome. Materials and methods: In this prospective observational study every live birth was screened by clinical examination and further relevant investigations. Study subjects were all live births in the calendar year 2015. Telephonic follow-up was undertaken at 2 months of age. Results: A total of 4493 neonates were born, out of which 127 babies had birth defects. The total number of individual birth defects was 153 (3.4%). The most common system involved was cardiovascular system. Conclusion: Early detection is essential for proper management of these defects and offers the best chance for survival. Followup of babies’ birth defects is highly recommended. Standard guidelines advocacy and policies at national level are needed. In resource-limited setting the novel way of telephonic follow-up is highly beneficial and economical.

Keywords: Newborns; Birth defects; Babies; India; Neonates.

Background: Severe acute malnutrition (SAM) remains a major health hazard to children, as the mortality rates among SAM children are nine times higher than those in well-nourished children. This study was conducted to assess the demographic features of malnourished children. Methods: A total of 100 malnourished children were included over a period of six months. A preliminary data of children regarding age, start of complimentary feeding (CF), maternal education, parity were noted. Anthropometric measurements such as height/length, weight, midupper arm circumference (MUAC) were recorded in all the patients. Results: Majority were in the age group of 6–18 months (64%) and least were in 45–59 months. Females were more with M:F ratio of 1:1.1. 94% of families resided in rural areas. Most of the children hailed from middle (58%), followed by lower (41%) class and one child belonged to upper socioeconomic class. About 70% of children were born to multiparous mothers. Approximately 50% children were of low-birth weight. Only 8% babies were bottle fed and in 76% children, weaning time was inappropriate. Conclusion: The short birth interval, low socio-economic status, lower mother's educational level and delay in the initiation of complimentary feeding were the important risk factors of SAM among children. Children with SAM need to be treated with special attention at the primary point of care to reduce mortality.

Keywords: Malnutrition, Anthropometry, Feeding.